Senior Heart Patients Need Help from Cardiac Rehab
Expert to Adhere to Healthy Habits
Mayo Clinic research shows that cardiac rehab can
extend life but is vastly underutilized
June
6, 2008 – It's a familiar pattern – the senior citizen suffers a serious
heart problem and comes out of the initial life-saving treatment
determined to do whatever it takes to live a healthier life. The diet,
the exercise – it all goes well for awhile and then, too often, the will
power and determination drastically diminishes. The answer could be a
cardiac "disease manager," according to researchers at Mayo Clinic in
Rochester, Minn.
People recovering from acute heart problems such as
heart attack and heart surgery are more likely to develop habits to
control heart attack risk factors when they meet regularly with a
cardiac disease manager, the study found in looking at a study group of
mostly senior citizens.
These managers are nonphysician cardiac
rehabilitation specialists who lead long-term follow-up programs that
last three years. With these risk factors under control, heart patients
are likely to live longer and have fewer heart problems, the Mayo
researchers conclude.
The Mayo Clinic researchers studied the effects of
a long-term cardiac disease manager model on 503 patients involved in
cardiac rehabilitation.
Patients entered the rehabilitation program in 1999
and 2000. Of the patients, 54 percent were 65 years or older. All had
suffered some form of acute cardiac event, such as a heart attack, or
had undergone heart surgery.
The disease manager's role was to monitor the
patient's status, and to coach the patients in adopting heart attack
prevention behaviors.
At each meeting, the following factors were
assessed and management strategies were discussed:
After initial rehabilitation training about risk
factor management, each patient met with a trained disease manager every
three to six months for three years.
Their report demonstrates:
● It is feasible to provide long-term disease
management to heart patients in an outpatient setting. Mayo's model
calls for trained cardiac rehabilitation specialists to function as
disease managers who maintain a relationship with the patients and meet
face-to-face every three to six months. This follows an initial
intensive training period about lifestyle changes and medications. In
contrast, aftercare programs often are only a few months long and lack
coordination and direct involvement of health care providers who are
specifically trained in cardiac rehabilitation, or who rigorously review
clinical and lifestyle data.
● The approach offers clear clinical benefits.
At three years, the participants attained and maintained most of the
behaviors for preventing subsequent heart attacks. These behaviors are
known as secondary heart-attack prevention measures. They include
exercising regularly and taking specific heart-protecting medications.
Most lowered their cholesterol levels and blood pressure to within
recommended levels. Of the 503 participants, compliance with aspirin
usage was 91 percent; statin usage, 91 percent; beta-blocker usage, 78
percent; and angiotensin-converting enzyme inhibitor usage, 76 percent.
● Patients in the disease manager model of care
versus traditional care had a lower death rate. While larger studies
will need to validate this finding, over the three years of the study,
29 participants died, (25 men and four women), an annual death rate of
1.9 percent. This compares to the Centers for Disease Control and
Prevention's expected annual death rate of 1.6 percent for Americans of
comparable ages in the general population without heart problems. By
comparison, the annual death rate over three years for an additional
group of 102 patients who were enrolled in cardiac rehabilitation but
who did not receive long-term disease management, was 6.5 percent.
● Being overweight remains a prevalent and
persistent risk factor for heart attack. As measured by body mass index,
being overweight was the one heart disease risk factor that did not
respond well to this disease manager approach. Other studies also have
shown body weight to be the most change-resistant variable in efforts to
promote heart health.
Significance of the Mayo Research
The findings are important because heart disease is
the number one cause of death and disability in the U.S. - and though
many people survive due to advances in medical care, many patients and
physicians don't realize the importance of cardiac rehabilitation in
extending survival benefits.
Mayo researchers developed the disease manager
model of cardiac rehabilitation to extend the lifesaving benefits modern
medicine offers, and spare patients the trauma and the expense of repeat
surgeries and hospitalizations, says lead researcher Ray Squires, Ph.D.
"Earlier studies indicate that under traditional
approaches, most patients don't comply with treatment recommendations,
including taking medications and modifying their lifestyle. We need to
change that," Dr. Squires says.
For example, he says that during 2004 in Minnesota,
38 percent of coronary heart disease patients received optimal care for
controlling heart attack prevention. The goals of heart attack
prevention for patients with coronary heart disease in the Minnesota
survey included:
● Achieving a low-density lipoprotein (LDL)
cholesterol of less than 100 milligrams per deciliter
-- Lowering blood pressure to less than 140 systolic and 90 diastolic
-- Taking a daily aspirin to help prevent blood clots
-- Quitting smoking
"This suggests the remaining 62 percent of
Minnesota coronary heart disease patients in 2004 remained at higher
risk of further heart problems," Dr. Squires says.
"Our feeling is that medical science can offer more
people better methods for living a heart-healthy - and longer - life. We
designed our cardiac rehabilitation program to do that. Using the
disease manager model, we have demonstrated that three years of
intervention in routine clinical practice was generally effective in
achieving secondary prevention goals."
Mayo's Leadership Role
Mayo Clinic is a leader nationally in emphasizing
the savings in lives and costs that cardiac rehabilitation offers heart
patients.
"Many studies demonstrate that cardiac
rehabilitation is extremely beneficial to patients, and the data also
show that cardiac rehab is vastly underutilized," says Randal Thomas,
M.D., director of the Cardiovascular Health Clinic at Mayo Clinic.
To improve the referral of patients to cardiac
rehabilitation programs and to stimulate high-quality care in cardiac
rehabilitation centers, Dr. Thomas recently helped draft new national
performance measures. Adding a disease manager into this approach
extends the benefits of cardiac rehabilitation, in his view.
"The kind of cardiac rehabilitation program we'd
like to see serves not only as a coach for the patient, but also as a
key communicator in patient care, and a coordinator with other health
care providers. When all those roles are filled, it's likely that
patients get the follow-up care they need," Dr. Thomas says.
About the Study
Their findings appear in The Journal of
Cardiopulmonary Rehabilitation and Prevention.
Mayo's study is based on a review of the clinical
progress made by 503 heart patients at Mayo treated under a long-term
management model led by cardiac rehabilitation experts.
Collaboration and Support
Other members of the research team are Aura
Montero-Gomez, M.D., and Thomas Allison, Ph.D. Their work was supported
by the Mayo Foundation for Medical Education and Research.
Keep up with the latest news for senior citizens, baby
bommers
June
6, 2008 – It's a familiar pattern – the senior citizen suffers a serious
heart problem and comes out of the initial life-saving treatment
determined to do whatever it takes to live a healthier life. The diet,
the exercise – it all goes well for awhile and then, too often, the will
power and determination drastically diminishes. The answer could be a
cardiac "disease manager," according to researchers at Mayo Clinic in
Rochester, Minn.
But majority of patients in study think they will
live longer than clinical prediction